Medicine and Health Sciences Commons^™

Impact Of Numeracy On Understanding Of Prostate Cancer Risk Reduction In Psa Screening, Kevin Koo, Charles D. Brackett, Ellen H. Eisenburg, Kelly A. Kieffer, Elias S. Hyams

Dartmouth Scholarship

Prostate-specific antigen (PSA) screening for prostate cancer in men of average risk remains controversial. Patients’ ability to incorporate risk reduction data into their decision-making may depend on their numeracy. We assessed the impact of patients’ numeracy on their understanding of the risk reduction benefits of PSA screening. Men attending a general internal medicine clinic were invited to complete a survey. Four versions of the survey each included a three-item numeracy test and PSA risk reduction data, framed one of four ways: absolute (ARR) versus relative risk reduction (RRR), with or without baseline risk (BR). Respondents were asked to adjust their …

Iron Reduction Response And Demographic Differences Between Diabetics And Non-Diabetics With Cardiovascular Disease Entered To A Controlled Clinical Trial, Leo Zacharski, Galina Shamayeva, Bruce Chow

Dartmouth Scholarship

Iron-catalyzed oxygen free radical-induced oxidative stress mediates the pathogenesis of diabetes and cardiovascular disease (CVD). Diabetics (n=473) and non-diabetics (n=804) with CVD entered to a randomized trial of iron (ferritin) reduction by calibrated phlebotomy (www.clinicaltrials.gov, Identifier NCT00032357) had comparable iron measures at entry but diabetics had greater burden of CVD and comorbidities, lower hemoglobin and hematocrit levels, and higher glucose levels than non-diabetics. Entry iron measures were lower in diabetics on hypoglycemic therapy compared to diabetics untreated previously. Diabetics and non-diabetics had comparable iron measures during follow-up. Loess analysis of paired ferritin and hemoglobin, and paired ferritin and glucose levels …

Vista Deficiency Attenuates Antibody-Induced Arthritis And Alters Macrophage Gene Expression In Response To Simulated Immune Complexes, Sabrina Ceeraz, Susan K. Eszterhas, Petra Sergent, David A. Armstrong, Alix Ashare, Thomas Broughton, Li Wang, Dov Pechenick, Christopher M. Burns, Randolph J. Noelle, Matthew P. Vincenti, Roy A. Fava

Dartmouth Scholarship

In addition to activated T cells, the immune checkpoint inhibitor “V domain-containing Ig suppressor of T-cell activation” (VISTA) is expressed by myeloid cell types, including macrophages and neutrophils. The importance of VISTA expression by myeloid cells to antibody-induced arthritis and its potential for relevance in human disease was evaluated. Methods: VISTA was immunolocalized in normal and arthritic human synovial tissue sections and synovial tissue lysates were subjected to western blot analysis. The collagen antibody-induced arthritis model (CAIA) was performed with DBA/1 J mice treated with antibodies against VISTA and with VISTA-deficient mice (V-KO). Total mRNA from arthritic joints, spleens, and …

Lung Malignancy In Prostate Cancer: A Report Of Both Metastatic And Primary Lung Lesions, Lael Reinstatler, Jonathan Dupuis, Jessica L. Dillon, Candace C. Black, Joseph D. Phillips, Elias S. Hyams

Dartmouth Scholarship

Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. When it metastasizes, it usually spreads to bone and/or lymph nodes. A handful of cases have described prostatic metastases to the lung; however, this is usually in the setting of existing bone lesions. Here we describe a unique case in which a patient was found to have both metastatic prostate cancer to the lung and a primary lung cancer in the absence of any other evidence of extra-prostatic disease.

Small Rna Teg49 Is Derived From A Sara Transcript And Regulates Virulence Genes Independent Of Sara In Staphylococcus Aureus, Adhar Manna, Samin Kim, Liviu Cengher, Anna Corvaglia, Stefano Leo, Patrice Francois, Ambrose L. Cheung

Dartmouth Scholarship

Expression of virulence factors in Staphylococcus aureus is regulated by a wide range of transcriptional regulators, including proteins and small RNAs (sRNAs), at the level of transcription and/or translation. The sarA locus consists of three overlapping transcripts generated from three distinct promoters, all containing the sarA open reading frame (ORF). The 5= untranslated regions (UTRs) of these transcripts contain three separate regions 711, 409, and 146 nucleotides (nt) upstream of the sarA translation start, the functions of which remain unknown. Re- cent transcriptome-sequencing (RNA-Seq) analysis and subsequent characterization indicated that two sRNAs, teg49 and teg48, are processed and likely produced …

Patient-Predicted Sleep Position Vs. Hst Data: A Tendency To Underestimate Supine Sleep, Adam J. Sorscher, Anthony P. Anzivino, Todd Mackenzie

Dartmouth Scholarship

Purpose The purpose of this study is to measure people’s accuracy when they estimate what proportion of their nightly sleep at home is supine vs. non-supine. Methods A series of patients referred for obstructive sleep apnea (OSA) evaluation were asked if they Bknew with confidence^ how they slept with regard to their body position. BYes^ responders were then asked to estimate what percentage of their sleep was supine vs. non-supine. This value was compared with the actual proportion of supine vs. non-supine sleep that they exhibited in a home sleep test (HST) that followed. Results We obtained data from 49 …

Addition Of T2-Guided Optical Tomography Improves Noncontrast Breast Magnetic Resonance Imaging Diagnosis., Jinchao Feng, Junqing Xu, Shudong Jiang, Hong Yin, Yan Zhao, Jiang Gui, Ke Wang, Xiuhua Lv, Fang Ren, Brian W. Pogue, Keith D. Paulsen

Dartmouth Scholarship

BACKGROUND:

While dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is recognized as the most sensitive examination for breast cancer detection, it has a substantial false positive rate and gadolinium (Gd) contrast agents are not universally well tolerated. As a result, alternatives to diagnosing breast cancer based on endogenous contrast are of growing interest. In this study, endogenous near-infrared spectral tomography (NIRST) guided by T2 MRI was evaluated to explore whether the combined imaging modality, which does not require contrast injection or involve ionizing radiation, can achieve acceptable diagnostic performance.

METHODS:

Twenty-four subjects-16 with pathologically confirmed malignancy and 8 with benign …

Intrinsic And Innate Defenses Of Neurons: Détente With The Herpesviruses, Lynn Enquist, David A. Leib

Dartmouth Scholarship

Neuroinvasive herpesviruses have evolved to efficiently infect and establish latency in neurons. The nervous system has limited capability to regenerate, so immune responses therein are carefully regulated to be nondestructive, with dependence on atypical intrinsic and innate defenses. In this article we review studies of some of these noncanonical defense pathways and how herpesvirus gene products counter them, highlighting the contributions that primary neuronal in vitro models have made to our understanding of this field.

Optimizing Fresh Specimen Staining For Rapid Identification Of Tumor Biomarkers During Surgery., Connor W. Barth, Jasmin M. Schaefer, Vincent M. Rossi, Scott C. Davis, Summer L. Gibbs

Dartmouth Scholarship

Rationale: Positive margin status due to incomplete removal of tumor tissue during breast conserving surgery (BCS) is a prevalent diagnosis usually requiring a second surgical procedure. These follow-up procedures increase the risk of morbidity and delay the use of adjuvant therapy; thus, significant efforts are underway to develop new intraoperative strategies for margin assessment to eliminate re-excision procedures. One strategy under development uses topical application of dual probe staining and a fluorescence imaging strategy termed dual probe difference specimen imaging (DDSI). DDSI uses a receptor-targeted fluorescent probe and an untargeted, spectrally-distinct fluorescent companion imaging agent topically applied to fresh resected …

Assessing Daylight & Low-Dose Rate Photodynamic Therapy Efficacy, Using Biomarkers Of Photophysical, Biochemical And Biological Damage Metrics In Situ., Ana Luiza Ribeiro De Souza, Ethan Larochelle, Kayla Marra, Jason Gunn, Scott C. Davis, Kimberley S. Samoke, M. Shane Chapman, Edward V. Maytin, Tayyaba Hasan, Brian W. Pogue

Dartmouth Scholarship

Background

Sunlight can activate photodynamic therapy (PDT), and this is a proven strategy to reduce pain caused by conventional PDT treatment, but assessment of this and other alternative low dose rate light sources, and their efficacy, has not been studied in an objective, controlled pre-clinical setting. This study used three objective assays to assess the efficacy of different PDT treatment regimens, using PpIX fluorescence as a photophysical measure, STAT3 cross-linking as a photochemical measure, and keratinocyte damage as a photobiological measure.

Methods

Nude mouse skin was used along with in vivo measures of photosensitizer fluorescence, keratinocyte nucleus damage from pathology, …

Anthropometric Factors And Cutaneous Melanoma: Prospective Data From The Population-Based Janus Cohort, Jo S. Stenehjem, Marit B. Veierød, Lill Tove Nilsen, Reza Ghiasvand, Bjørn Johnsen, Tom K. Grimsrud, Ronnie Babigumira, Judy R. Rees, Trude E. Robsahm

Dartmouth Scholarship

The aim of the present study was to prospectively examine risk of cutaneous melanoma (CM) according to measured anthropometric factors, adjusted for exposure to ultraviolet radiation (UVR), in a large population-based cohort in Norway. The Janus Cohort, including 292,851 Norwegians recruited 1972–2003, was linked to the Cancer Registry of Norway and followed for CM through 2014. Cox regression was used to estimate hazard ratios (HRs) of CM with 95% confidence intervals (CIs). Restricted cubic splines were incorporated into the Cox models to assess possible non-linear relationships. All analyses were adjusted for attained age, indicators of UVR exposure, education, and smoking …

Non-Aggregated Aβ25-35 Upregulates Primary Astrocyte Proliferation In Vitro, Elise C. Ohki, Thomas J. Langan, Kyla R. Rodgers, Richard C. Chou

Dartmouth Scholarship

Amyloid beta (Aβ) is a peptide cleaved from amyloid precursor protein that contributes to the formation of senile plaques in Alzheimer’s disease (AD). The relationship between Aβ and astrocyte proliferation in AD remains controversial. Despite pathological findings of increased astrocytic mitosis in AD brains, in vitro studies show an inhibitory effect of Aβ on astrocyte proliferation. In this study, we determined the effect of an active fragment of Aβ (Aβ_25-35) on the cell cycle progression of primary rat astrocytes. We found that Aβ_25-35 (0.3–1.0 μg/ml) enhanced astrocyte proliferation in vitro in a time- and concentration-dependent manner. Increased …

Quantity Over Quality—Findings From A Systematic Review And Environmental Scan Of Patient Decision Aids On Early Abortion Methods, Kyla Z. Donnelly, Glyn Elwyn, Rachel Thompson

Dartmouth Scholarship

Background: The availability and effectiveness of decision aids (DAs) on early abortion methods remain unknown, despite their potential for supporting women’s decision making. Objective: To describe the availability, impact and quality of DAs on surgical and medical early abortion methods for women seeking induced abortion. Search strategy: For the systematic review, we searched MEDLINE, Cochrane Library, CINAHL, EMBASE and PsycINFO. For the environmental scan, we searched Google and App Stores and consulted key informants. Inclusion criteria: For the systematic review, we included studies evaluating an early abortion method DA (any format and language) vs a comparison group on women’s decision …

Pneumoscrotum With Extensive Penile And Abdominal Subcutaneous Emphysema: A Case Report Of Uncertain Etiology, Eric Raffin, Gina Tundo, Florian Schroek

Dartmouth Scholarship

Pneumoscrotum and subcutaneous emphysema make for impressive findings on examination and imaging. With ranging etiologies, thorough investigation into the source is essential to rule out potentially life threatening situations. We present a 31-year-old man with pneumoscrotum and extensive subcutaneous emphysema of his penis, abdomen, and perineum. History and physical exam didn't reveal a clear cause and he subsequently underwent surgical exploration showing no soft tissue infection. On post-operative day 1, he remained clinically stable and was discharged. Despite the usual benign nature of pneumoscrotum, full assessment is necessary to identify possible underlying conditions of significant morbidity and mortality.

Assembling And Validating Data From Multiple Sources To Study Care For Veterans With Bladder Cancer, Florian R. Schroek, Brenda E. Sirovich, John D. Seigne, Douglas J. Robertson, Philip P. Goodney

Dartmouth Scholarship

Despite the high prevalence of bladder cancer, research on optimal bladder cancer care is limited. One way to advance observational research on care is to use linked data from multiple sources. Such big data research can provide real-world details of care and outcomes across a large number of patients. We assembled and validated such data including (1) administrative data from the Department of Veterans Affairs (VA), (2) Medicare claims, (3) data abstracted by tumor registrars, (4) data abstracted via chart review from the national electronic health record, and (5) full text pathology reports.

“Provoking Conversations”: Case Studies Of Organizations Where Option Grid™ Decision Aids Have Become ‘Normalized’, Peter Scalia, Glyn Elwyn, Marie-Anne Durand

Dartmouth Scholarship

Background: Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Method: Case studies conducted by semi-structured interview, using the Normalization Process Theory (NPT) as a framework for thematic analysis. Twenty three interviews with physicians, nurses, hospital staff and stakeholderswere conducted at: 1) CapitalCare Medical Group in Albany, New York; 2) HealthPartners Clinics in Minneapolis, Minnesota. Results: ‘Coherent’ motivations were guided by financial incentives at CapitalCare, …

Collagen Complexity Spatially Defines Microregions Of Total Tissue Pressure In Pancreatic Cancer., Michael D. Nieskoski, Kayla Marra, Jason R. Gunn, P. Jack Hoopes, Marvin M. Doyley, Tayyaba Hasan, B. Stuart Trembly, Brian W. Pogue

Dartmouth Scholarship

The poor efficacy of systemic cancer therapeutics in pancreatic ductal adenocarcinoma (PDAC) is partly attributed to deposition of collagen and hyaluronan, leading to interstitial hypertension collapsing blood and lymphatic vessels, limiting drug delivery. The intrinsic micro-regional interactions between hyaluronic acid (HA), collagen and the spatial origins of mechanical stresses that close off blood vessels was investigated here. Multiple localized pressure measurements were analyzed with spatially-matched histochemical images of HA, collagen and vessel perfusion. HA is known to swell, fitting a linear elastic model with total tissue pressure (TTP) increasing above interstitial fluid pressure (IFP) directly with collagen content. However, local …

Hyperspectral Data Processing Improves Ppix Contrast During Fluorescence Guided Surgery Of Human Brain Tumors., Jaime J. Bravo, Jonathan D. Olson, Scott C. Davis, David W. Roberts, Keith D. Paulsen, Stephen C. Kanick

Dartmouth Scholarship

Fluorescence guided surgery (FGS) using aminolevulinic-acid (ALA) induced protoporphyrin IX (PpIX) provides intraoperative visual contrast between normal and malignant tissue during resection of high grade gliomas. However, maps of the PpIX biodistribution within the surgical field based on either visual perception or the raw fluorescence emissions can be masked by background signals or distorted by variations in tissue optical properties. This study evaluates the impact of algorithmic processing of hyperspectral imaging acquisitions on the sensitivity and contrast of PpIX maps. Measurements in tissue-simulating phantoms showed that (I) spectral fitting enhanced PpIX sensitivity compared with visible or integrated fluorescence, (II) confidence-filtering …

Using Collaborate, A Brief Patient-Reported Measure Of Shared Decision Making: Results From Three Clinical Settings In The United States, Rachel C. Forcino, Paul James Barr, A. James O'Malley, Roger Arend, Molly G. Castaldo, Elissa M. Ozanne, Sanja Percac-Lima, Cheryl D. Stults, Ming Tai-Seale, Rachel Thompson, Glyn Elwyn

Dartmouth Scholarship

No abstract provided.

Emphysematous Pyelonephritis With Renal Artery Pseudoaneurysm, Kevin Koo, Elias S. Hyams

Dartmouth Scholarship

Emphysematous pyelonephritis is an acute infection of the renal parenchyma and perinephric tissues caused by gas-forming microorganisms, resulting in the radiographic presence of gas in the kidney, collecting system, and surrounding spaces. Here we present a case of severe emphysematous pyelonephritis in the setting of Klebsiella urosepsis. Surgical exploration of the flank revealed infectious disintegration of the renal parenchyma into a large phlegmon. The post-operative course was complicated by renal artery pseudoaneurysm and cutaneous fistualization of a perinephric fluid collection. Despite the high rate of mortality associated with this condition, the patient survived and has remained clinically well.

Assessing Medical Student Knowledge And Attitudes About Shared Decision Making Across The Curriculum: Protocol For An International Online Survey And Stakeholder Analysis, Marie-Anne Durand, Renata Yen, Paul J. Barr, Nan Cochran, Johanna Aarts, France Legare, Malcolm Reed, A. James O'Malley, Peter Scalia, Genevieve Painchaud Guérard, Glyn Elwyn

Dartmouth Scholarship

INTRODUCTION:

Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students knowledge of and attitudes towards SDM in four countries.

METHODS AND ANALYSIS:

The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate …

Anxiety Associated Increased Cpg Methylation In The Promoter Of Asb1: A Translational Approach Evidenced By Epidemiological And Clinical Studies And A Murine Model, Rebecca T. Emeny, Jens Baumert, Anthony S. Zannas, Sonja Kunze, Simone Wahl, Stella Iurato

Dartmouth Scholarship

Epigenetic regulation in anxiety is suggested, but evidence from large studies is needed. We conducted an epigenome-wide association study (EWAS) on anxiety in a population-based cohort and validated our finding in a clinical cohort as well as a murine model. In the KORA cohort, participants (n= 1522, age 32–72 years) were administered the Generalized Anxiety Disorder (GAD-7) instrument, whole blood DNA methylation was measured (Illumina 450K BeadChip), and circulating levels of hs-CRP and IL-18 were assessed in the association between anxiety and methylation. DNA methylation was measured using the same instrument in a study of patients with anxiety disorders recruited …

A Protocol For Prospective Studies" "5-Hydroxyvitamin D, Leptin And B Ass Index In Relation To Cutaneou Elanoma Incidence And Survival, Jo S. Stenehjem, Tom K. Grimsrud, Judy R. Rees, Linda Vos, Ronnie Babigumira, Marit B. Veierød, Trude E. Robsahm

Dartmouth Scholarship

Introduction The incidence and mortality rates of

cutaneous melanoma (CM) are increasing among fai skinned populations worldwide. Ultraviolet radiation s the principal risk factor for CM, but is also the mai source of 25-hydroxyvitamin D (25(OH)D), which has associated with reduced risk and better prognosis of cancer types. However, both low and high 25(OH)D l have been associated with increased risk of CM. Obe as measured by body mass index (BMI) is associated risk of several cancers and has also been suggested risk factor for CM, and may also be related to insuffi 25(OH)D and/or high leptin levels. Moreover, contract …

Obesity, Metabolic Factors And Risk Of Different Histological Types Of Lung Cancer: A Mendelian Randomization Study, Robert Carreras-Torres, Mattias Johansson, Philip C. Haycock, Kaitlin H. Wade, Caroline L. Relton, Richard M. Martin, George Davey Smith, Demetrius Albanes, Melinda C. Aldrich, Angeline Andrew, Susanne M. Arnold, Heike Bickeböller, Stig E. Bojesen, Hans Brunnstrom, Jonas Manjer, Irene Brüske, Neil E. Caporaso, Chu Chen, David C. Christiani, W. Jay Christian, Jennifer Doherty, Eric J. Duell, John K. Field, Michael P.A Davies, Michael W. Marcus, Gary E. Goodman, Kjell Grankvist, Aage Haugen, Yun-Chul Hong, Lambertus A. Kiemeney, Erik H.F.M Van Der Heijden, Peter Kraft, Mikael B. Johansson, Stephen Lam, Maria Teresa Landi, Philip Lazarus, Loic Le Marchand, Geoffrey Liu, Olle Melander, Sungshim L. Park, Gad Rennert, Angela Risch, Eric B. Haura, Ghislaine Scelo, David Zaridze, Anush Mukeriya, Milan Savić, Jolanta Lissowska, Beata Swiatkowska, Vladmir Janout, Ivana Holcatova, Dana Mates, Matthew B. Schabath, Hongbing Shen, Adonina Tardon, M. Dawn Teare, Penella Woll, Ming-Sound Tsao, Xifeng Wu, Jian-Min Yuan, Rayjean J. Hung, Christopher I. Amos, James Mckay, Paul Brennan

Dartmouth Scholarship

Background: Assessing the relationship between lung cancer and metabolic conditions is challenging because of the confounding effect of tobacco. Mendelian randomization (MR), or the use of genetic instrumental variables to assess causality, may help to identify the metabolic drivers of lung cancer. Methods and findings: We identified genetic instruments for potential metabolic risk factors and evaluated these in relation to risk using 29,266 lung cancer cases (including 11,273 adenocarcinomas, 7,426 squamous cell and 2,664 small cell cases) and 56,450 controls. The MR risk analysis suggested a causal effect of body mass index (BMI) on lung cancer risk for two …

Leiomyosarcoma Of The Inferior Turbinate, Christopher W. Harper Jr., Marc A. Polacco, John R. Newman

Dartmouth Scholarship

We report a case of leiomyosarcoma of the inferior nasal turbinate. The patient, a 68-year-old Caucasian male, presented with 4–6 weeks of epistaxis that was resistant to nasal packing and septal cautery. Upon inspection in the operating room, a small mass was excised from the inferior turbinate. High-power H&E-stained microscopy demonstrated bundles of malignant smooth muscle cells, and immunohistochemical stains were strongly positive for desmin, smooth muscle actin and vimentin, while negative for pankeratin EA1/EA3 and CaM 5.2, suggesting leiomyosarcoma as the diagnosis. Clear margins were obtained at a second surgery. At the time of this writing it is 8 …

Safety And Immunogenicity Of An Inactivated Whole Cell Tuberculosis Vaccine Booster In Adults Primed With Bcg: A Randomized, Controlled Trial Of Dar-901, C. Fordham Von Reyn, Timothy Lahey, Robert D. Arbeit, Bernard Landry, Leway Kailani, Lisa Adams, Brenda Haynes, Todd Mackenzie, Wendy Wieland-Alter, Ruth Connor, Sue Tvaroha, David Hokey, Ann Ginsberg, Richard Waddell

Dartmouth Scholarship

Development of a tuberculosis vaccine to boost BCG is a major international health priority. SRL172, an inactivated whole cell booster derived from a non-tuberculous mycobacterium, is the only new vaccine against tuberculosis to have demonstrated efficacy in a Phase 3 trial. In the present study we sought to determine if a three-dose series of DAR-901 manufactured from the SRL172 master cell bank by a new, scalable method was safe and immunogenic.

Diffusion Of Digital Breast Tomosynthesis Among Women In Primary Care: Associations With Insurance Type, Cheryl R. Clark, Tor Tosteson, Anna Tosteson, Tracy Onega, Julie Weiss, Kimberly A. Harris, Jennifer S. Haas

Dartmouth Scholarship

Digital breast tomosynthesis (DBT) has shown potential to improve breast cancer screening and diagnosis compared to digital mammography (DM). The FDA approved DBT use in conjunction with conventional DM in 2011, but coverage was approved by CMS recently in 2015. Given changes in coverage policies, it is important to monitor diffusion of DBT by insurance type. This study examined DBT trends and estimated associations with insurance type. From June 2011 to September 2014, DBT use in 22 primary care centers in the Dartmouth -Brigham and Women's Hospital Population-based Research Optimizing Screening through Personalized Regimens research center (PROSPR) was examined among …

Optimal Nutrition For Endurance Exercise: A Systematic Review, Sarah E. Andrus Ms, Bruce W. Andrus Md Ms

Dartmouth Scholarship

Introduction

As fatigue in endurance events correlates with depletion of muscle glycogen, the traditional approach to nutritional support has been carbohydrate loading. However, there has been recent interest in improving athletic endurance performance by novel diets in the days to weeks prior to endurance events, the pre-event meal, and during exercise.

Methods

We searched PubMed and SCOPUS for randomized trials published from 1992-2017 with a primary endpoint of endurance performance. We identified 407 citations which were examined against our inclusion criteria of randomization or crossover allocation to diet and for which a primary outcome was endurance performance.

Results

Twenty full …

Methotrexate Encephalopathy: Two Cases In Adult Cancer Patients, Who Recovered With Pathophysiologically Based Therapy, Shodeinde A. Coker, David A. Pastel, Melissa C. Davis, Elizabeth M. Bengston, Camilo E. Fadul, Lionel D. Lewis

Dartmouth Scholarship

Background/Objectives: Neurotoxicity is a serious and sometimes fatal adverse effect that can occur following methotrexate treatment. We describe two adult patients with hematological malignancies with methotrexate encephalopathy who recovered with dextromethorphan therapy. Results: Case 1 : A 24-year-old male with acute lymphoblastic leukemia developed the acute onset of bilateral facial weakness and slurred speech after his first treatment with high-dose intravenous methotrexate. The clinical scenario and a head magnetic resonance imaging supported a diagnosis of methotrexate encephalopathy. Treatment with dextromethorphan was coincident with recovery. Case 2 : A 65-year-old female with recurrent diffuse large B-cell lymphoma was treated with high- …

Levels Of Infants’ Urinary Arsenic Metabolites Related To Formula Feeding And Weaning With Rice Products Exceeding The Eu Inorganic Arsenic Standard, Antonio J. Signes-Pastor, Jayne V. Woodside, Paul Mcmullan, Karen Mullan, Manus Carey, Margaret R. Karagas, Andrew A. Meharg

Dartmouth Scholarship

Early childhood inorganic arsenic (i-As) exposure is of particular concern since it may adversely impact on lifetime health outcomes. Infants’ urinary arsenic (As) metabolites were analysed in 79 infants by inductively coupled plasma—mass spectrometric detection (IC-ICP-MS) to evaluate i-As exposure pre- and post-weaning. Levels of i-As in rice-based weaning and infants’ foods were also determined to relate to urinary As levels. Higher As levels, especially of monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA), were found in urine from formula fed infants compared to those breastfed. Urine from infants post-weaning consuming rice-products resulted in higher urinary MMA and DMA compared to …